UN: Improved Access to HIV/AIDS Treatment Reduces Number of AIDS-related Deaths
The United Nations’ annual report on HIV infections and AIDS related-deaths around the world concluded that increased access to treatment in poorer and middle-income countries has led to positive health outcomes. “AIDS-related deaths in 2012 fell to 1.6 million, down from 1.7 million in 2011 and a peak of 2.3 million in 2005. And the number of people newly infected with the disease dropped to 2.3 million in 2012 down from 2.5 million in 2011.” The executive director of UNAIDS, Michel Sidibé, said that the international community is well on its way to surpass the 2015 goals of expanding access to treatment. Read more on the public health impact of AIDS.

Racism Leads to Negative Effects on Mental Health of Children and Teens
A new report published in the journal Social Science & Medicine examines the link between the mental health and well-being of youth ages 12-18 and racism. The review shows that being a victim of racial discrimination can lead to low self-esteem, reduced resilience, and increased behavior problems. There was also evidence of increased risk of poorer birth outcomes for children when mother experienced racism while pregnant. These types of detriments to children and teen’s mental health and well-being can lead to larger problems in terms of engagement in education and employment later in life, according to study authors. Read more on health disparities.

Positive Relationships May Help Break the Cycle of Maltreatment
In a special supplement released by the Journal of Adolescent Health, investigations on the effects of safe, stable, nurturing relationships found that these types of relationships could help break the cycle of child maltreatment that is often passed along from parents to children. Findings also showed that supportive and nurturing relationships between adults can help protect children as well. This study can provide helpful prevention strategies for breaking the cycle of maltreatment and promoting improved health in the long term. Read more on violence prevention.

Higher Education Linked to Better Obesity Rates for Women in Poorer Areas
Higher education is a key factor that helps protect women in economically disadvantaged areas from obesity, according to a new study in the American Journal of Health Promotion. “It is possible that education is a marker of an individual’s access to health information, capacity to assimilate health-related messages, and ability to retain knowledge-related assets, such as nutrition knowledge,” wrote the study’s authors. Previous studies have shown that women living in area with fewer economic resources have higher body mass index (BMI) than other women. The results indicate that both low education and personal income should be addressed by obesity prevention initiatives. Read more on obesity.

Regular Exercise May Help Decrease Depression
Increases in exercise may be linked to decreases in depression, according to a new review of existing research by The Cochrane Library. The researchers found people with depression who also exercised saw a “moderate” reduction in their symptoms when compared to people who did instead used relaxation techniques or received no treatment. Antidepressant medications and psychotherapy are the most common treatments for depression, which affects about 10 percent of Americans, according to the U.S. Centers for Disease Control and Prevention. More research is needed to better understand the relationship between exercise and depression symptoms. Still, Madhukar Trivedi, MD, a professor of psychiatry at the UT Southwestern Medical Center in Dallas, who was not a part of the study, said one of the keys is making sure patients stick with the exercise regimen. "Once people are prescribed exercise or they choose exercise, the big challenge is to make the exercise real," he said. "If the recommendation from the treating clinician is that you should be exercising with some frequency and intensity…it's important that the patient follow that regimen week after week.” Read more on mental health.

Predominantly Black Nursing Homes Deliver Lower Levels of Care, Perform Worse Financially
Nursing homes that are predominantly populated by black residents deliver overall poorer care and are less successful financially than homes with few or not minority residents, according to a new study in Health Services Research. The study looked at issues such as the ratio of nursing staff to patients, success in preventing pressure ulcers, help with walking, help with getting out of bed, prevention of urinary tract infections, the incidence of medication errors and citations by governmental agencies. However, the study noted that black and white patients living in the same facilities received equal treatments, meaning the disparity is not due to any biases of health care workers. One factor leading to the disparity could be the fact that older black Americans are more likely to rely on Medicaid, which means lower reimbursement rates. Still, Latarsha Chisholm, assistant professor at the University of Central Florida and study author, believes something more must be at play. "It isn't only the financial performance [of nursing homes] that affects performance," she said. "There has to be something else affecting quality. I want to understand what management practices promote improved care in nursing homes with high proportions of minorities that don't have disparities in care.” Read more on health disparities.

Have you heard the story about the Prevention and Public Health Fund? A “no” wouldn’t be surprising.

Have you heard the story about the almost 200,000 preventable deaths in the United States each year due to heart disease and stroke? Probably so.

The latter was big news last week, inspiring headlines and handwringing across the country. Men are twice as likely as women to die of preventable cardiovascular disease. Blacks are twice as likely as whites. Southerners are at far greater risk.

Most of the stories emphasized how all this unhealthy living is the result of unhealthy lifestyle choices. But is that the whole story?

“Largely absent from most of the stories covering the study was context—a hard look at the social and environmental conditions that help explain the findings—as well as some explanation of what it might take to really change things and prevent large numbers of needless deaths.” They also tended to suggest “that poor health is essentially a personal moral failing, while ignoring the vastly different realities that exist in different communities in this country.”

That’s the thesis of a recent Forbes opinion piece, which looks past the round number of “200,000” and other statistics detailed by the U.S. Centers for Disease Control and Prevention (CDC), and points attention to the very real obstacles to healthy living that far too many people face.

The CDC study also discussed the importance of addressing the economic and social determinants that influence the health of individuals and communities (though this went largely unacknowledged in most media accounts, according to the Forbes piece). The CDC pointed out strategies that help create conditions for healthier living, including policy changes that increase access to health care, that give people healthy local food options and that build walkable communities—changes that can only be made by communities, not individuals.

That brings us back to the Prevention and Public Health Fund. Created by the Affordable Care Act, the Fund’s grantees have spent the past three years doing all these things—helping states, cities and tribes create safer, healthier communities.

“That’s a story that needs to be told, with context.”

>>Read the full piece, “200,000 Preventable Deaths A Year: Numbers That Cry Out For Action -- And Better Reporting.”

‘Hyper-vigilance’ Over Racial Disparities May Be a Factor in Higher Hypertension Rates for Black Americans
“Hyper-vigilance” related to race consciousness may be a factor in why black Americans have a disproportionately high rate of hypertension, according to a new study in the American Journal of Hypertension from researchers at the Johns Hopkins University School of Medicine. While it’s long been known that blacks have, on average, higher blood pressure, the exact environmental factors that contribute to the higher rates are not fully understood, according to Lisa A. Cooper, MD, MPH, a professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine and the study’s senior author. “Hyper-vigilance [is] a heightened awareness of their stigmatized status in society and a feeling that they need to watch their backs constantly,” she said. “African-Americans have higher blood pressure, and it has been difficult to explain why this is true. It doesn’t appear to be genetic, and while things like diet, exercise and reduced access to health care may contribute, we think that a tense social environment, the sense of being treated differently because of your race, could also possibly explain some of what’s behind the higher rates.” Read more on health disparities.

Survey: Most Women Don’t Know their Personal Breast Cancer Risk
A new survey of more than 9,000 women shows that far too few have an accurate idea of their personal risk of developing breast cancer in their lifetime. Study researcher Jonathan Herman, MD, an obstetrician and gynecologist at Hofstra North Shore-LIJ Medical School in New Hyde Park, N.Y., found that only 9.4 percent knew their risk level, nearly 45 percent underestimated their level and nearly 46 percent overestimated their level. The survey also found that about four in 10 women had never even discussed their personal breast cancer risk with a physician. On average, women have a 12 percent lifetime risk of breast cancer, with that number climbing 20 percent if their mother had breast cancer. The BRCA mutations that increase breast cancer risk push the risk to about 70 percent. Mary Daly, MD, chair of clinical genetics at Fox Chase Cancer Center, in Philadelphia, and director of its risk assessment program, said it is critical that women researcher their family history related to breast cancer in order to determine whether they are following the best possible screening schedule. Read more on cancer.

Harsh Verbal Discipline of Teens Only Makes Behavior Worse
Harsh verbal discipline of teenagers not only isn’t effective at changing bad behaviors, but can in fact make them worse, according to a new study in the journal Child Development. "Most parents who yell at their adolescent children wouldn't dream of physically punishing their teens," said study author Ming-Te Wang, an assistant professor with the department of psychology at the University of Pittsburgh School of Education. "Yet, their use of harsh verbal discipline—defined as shouting, cursing or using insults—is just as detrimental to the long-term well-being of adolescents.” A recent survey indicates that about nine in 10 parents have admitted to such behavior. The study found that the emotional pain and discomfort cause by harsh parental verbal abuse can increase anger while dropping inhibition, which in turn can promote behaviors such as lying, cheating, stealing and fighting. It also found that the concept of “parental warmth”—as in a parent was yelling out of love or for the child’s own good—didn’t make things any better. "Parents who wish to modify their teenage children's behavior would do better by communicating with them on an equal level…and explaining their rationale and worries to them,” said Wang. “Parenting programs are in a good position to offer parents insight into how behaviors they may feel the need to resort to, such as shouting or yelling, are ineffective and or harmful, and to offer alternatives to such behaviors." Read more on pediatrics.

Tomorrow from 12 p.m. to 2 p.m. EST Legacy will hold a special online panel discussion as part of the Kenneth E. Warner Lecture Series that puts a spotlight on the social influences on tobacco use and tobacco-related death and disease. The panel will discuss the disproportionate impact of tobacco by race, ethnicity, sexual orientation and socio-economic status to help identify strategies to tackle tobacco-related health inequities.

>>View the live webcast Thursday, August 15, from 12 p.m. to 2 p.m. EST.

Paula Braveman, MD, MPH, a panelist as well as director of the Center on Social Disparities in Health at the University of California San Francisco and Research Director of the Robert Wood Johnson Foundation Commission to build a Healthier America, spoke with NewPublicHealth about the upcoming discussion.

“The purpose of the discussion,” said Dr. Braveman, “is to give wider attention to disparities in tobacco-related health consequences, and to reach a wider audience on the issue of disparities so that it can be dealt with in a more focused way than it has been up until now.”

Dr. Braveman says that a targeted focus is important for ethical and economic reasons. “The consequences of disparities in smoking and tobacco-related illness take a huge economic toll in terms of lost worker productivity and medical expenses that otherwise would not have been needed and in terms of suffering and loss of life. Using the disparities frame helps us to see that the health condition of people who are best off should be possible for everyone.”

Study: Pertussis Booster Only ‘Moderately’ Effective
The “booster” vaccine for pertussis—or whooping cough—is only “moderately” effective in preventing the disease in adolescents and adults, according to a new study in the journal BMJ. The Kaiser Permanente-backed study, which is the first to look at the effectiveness of the Tdap booster shot in the new generation that has only received acellular vaccines, found the effectiveness to be between 53 and 64 percent. This indicates that additional vaccinations may be required to adequately prevent outbreaks according to lead author Roger Baxter, MD, co-director of the Kaiser Permanente Vaccine Study Center. The state of California saw its highest number of cases of pertussis in more than 60 years in 2010, when it had more than 9,000 cases that led to 809 hospitalizations and 10 deaths, according to the National Center for Biotechnology Information. Read more on vaccines.

NYC Hospitals Prescribing Fruits, Vegetables to At-risk Youth
An apple a day to keep the doctor away? At two New York City hospitals, you can get a prescription for just that. Under a four-month pilot program, doctors at Lincoln Medical Center in the Bronx and Harlem Hospital are giving prescriptions for fruits and vegetables to at-risk youths. The kids and their families receive coupons which can be redeemed for product at local farmers markets and city green carts. “This is probably going to prevent an awful lot more disease over the long-term than a lot of the medicines we tend to write for,” said New York City Health Commissioner Thomas Farley, MD, said Tuesday in the green market outside Lincoln Medical Center. Read more on nutrition.

Breast Cancer Survival Times Shorter for Black Women
The fact that black women receive less health care overall than their white counterparts, combined with the lack of early screening and detection programs in many black communities, means they live an average of three fewer years with a breast cancer diagnosis, according to a new study in The Journal of the American Medical Association. Researchers at the University of Pennsylvania found that black women were less likely to receive an early diagnosis when the cancer was more treatable; they also found that quality of care was in general lower, though not enough to explain the survival gap. Data showed that 70 percent of white women lived at least five years after a breast cancer diagnosis, compared to 56 percent of black women. “Something is going wrong,” said Jeffrey H. Silber, MD, a professor at the University of Pennsylvania and the director of the Center for Outcomes Research at the Children’s Hospital of Philadelphia, which studies disparities in health care. “These are huge differences. We are getting there too late. That’s why we are seeing these differences in survival.” Read more on cancer.

Adults with Mobility Issues Have Higher Rates of Obesity, Chronic Illness
Adults with a disability that causes mobility issues are more likely to be obese or suffer from a chronic illness, according to a new study in the American Journal of Preventative Medicine. The chronic illnesses include those commonly linked to overall health and exercise, such as diabetes, hypertension and high cholesterol. They are also twice as likely to take medication for hypertension and lipid-lowering medicine. Researchers say the findings demonstrate the need for health care providers to emphasize lifestyle changes and exercise over just medication. “Health care providers face a challenge when it comes to helping their patients with a disability manage their weight when exercise and physical activity play such an important role in weight management,” said Katherine Froehlich-Grobe, PhD, lead author of the paper and associate professor of health promotion and behavioral science at The UT School of Public Health Dallas Regional Campus. “People with disabilities are underserved by national efforts aiming at reducing and preventing obesity. We must focus on managing and reducing weight for individuals with a disability.” About 54 million Americans have a disability. Read more on obesity.

Study: One in Four Injured Youth in ER Visits Had a Gun
In a study of emergency room treatments for assault injuries in teenagers and young adults in Michigan, approximately one in four of the injured reported owning or carrying a gun. The study appeared in the journal Pediatrics. Researchers found that most were obtained illegally, and while “well-off young men” were most likely to have a gun, the rate did not vary by race. According to a 2003 study, the rate of gun homicides for Americans 15 to 24 years old were about 40 times higher than the rates in comparable nations. While it recommends against guns in the home, the American Academy of Pediatrics says gun-owning families with children should keep guns locked and separate from ammunition. Lead researcher Patrick Carter, MD, from the University of Michigan in Ann Arbor, said more programs need to be developed to prevent future gun violence, but in the mean time communities with high rates of violence need to place more emphasis on safety and responsibility when it comes to discussing guns with youth and young adults. "I would say to parents, talk to your kids about firearms and the dangers associated with firearms and try to look at ways to prevent kids from getting involved in both substance use and violence," he said. Read more on violence.

Even With Same Care, Black Blood Cancer Patients Have Worse Outcomes than White Patients
Even when they receive the same type and level of care, black Americans with chronic lymphocytic leukemia (CLL) do not live as long as white Americans with the same blood cancer, according to a new study in the journal Cancer. While black patients generally saw a shorter time between diagnosis and referral, they also had more advanced CLL at the time of referral and their cancers progressed more quickly. The researchers from the University of Texas M.D. Anderson Cancer Center in Houston and Duke University Medical Center in Durham, N.C., said that biological factors may account for the different survival rates. Research consistently shows that minority patients tend to have worse cancer outcomes than white patients; poverty and access to care have also been identified as potential factors. Read more on health disparities.

Just a few metro stops can mean the difference between an extra five to ten years added to your lifespan. Using new city maps, the Commission to Build a Healthier America, which reconvened recently after a four year hiatus, is illustrating the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.

For too many people, making healthy choices can be difficult because the barriers in their communities are too high—poor access to affordable healthy foods and limited opportunities for exercise, for example. The focus for the Commission’s 2013 deliberations will be on how to increase opportunities for low-income populations to make healthier choices.  

The two maps of the Washington, D.C. area and New Orleans help to quantify the differences between living in certain parts of the region versus others.

Living in Northern Virginia’s Fairfax and Arlington Counties instead of the nearby District of Columbia, a distance of no more than 14 miles, can mean about six or seven more years in life expectancy. The same disparity exists between babies born at the end of the Washington Metropolitan Transit Authority’s (known as the Metro) Red Line in Montgomery County—ranked second out of 24 counties in the County Health Rankings, metrics developed by the Robert Wood Johnson Foundation and the University of Wisconsin to show the health of different counties—and those born and living at the end of the Metro’s Blue Line in Prince George’s County, which ranked 17th in the County Health Rankings.

At least two million children in the U.S. have at least one parent in prison, a situation now recognized as an adverse childhood experience, which can put children at risk for poor mental and physical health, due in part to isolation and a lack of family connectedness with their incarcerated parents. 

The Osborne Association, based in New York City, works with people who have been in conflict with the law, and their families. Osborne is currently using funding from a Robert Wood Johnson Foundation Roadmaps to Health community grant to advocate for the use of Family Impact Statements in New York State during prison sentencing and the inclusion of "proximity to children" as a factor in prison assignments in New York State. Family Impact statements convey to a judge how the family of a person convicted of a crime will be affected by various sentencing decisions. With their proximity advocacy, the goal is to increase visiting opportunities for families during periods of incarceration by assigning parents to closer prisons and expanding opportunities for kids to have contact with incarcerated parents through televisiting. Research has shown that having strong family ties increases the likelihood of family reunification following a parent’s prison stay, as well as the child’s long-term health and wellbeing. The goal of both policy reform efforts is to reduce the trauma of parent-child separation for children, thereby promoting their health and well-being.

Elizabeth Gaynes, Osborne’s executive director, was recognized recently as a White House Champion of Change for her work with the children of incarcerated parents. NewPublicHealth spoke with Gaynes about ways to protect the health and wellbeing of the 2.7 million children whose parents are in prison on any given day. Gaynes also spoke about how her former husband, the father of her two children, spent over twenty years in prison, and the impact this had on her family.

NewPublicHealth: Why do you think this issue of parental incarceration has not gotten enough attention previously?

Elizabeth Gaynes: There is no specific agency with direct responsibility for kids of incarcerated parents and the kids don’t tend to identify themselves. And until recently it wasn’t thought of as anything that needed identifying. When I was looking for a therapist for my kids, the people I spoke to said “we would treat this like any other abandonment.” And I said, “Really? But he didn’t actually abandon them.” So I think that there is no system that is responsible for them and because of the stigma they don’t self-identify. We’ve had some young people who went to do talks in high schools and asked the kids in the class at the beginning if they knew anyone who was in, or had been in, prison. At the beginning of her talk, two kids raised their hands. She said after she spoke and said her own dad had been in prison, she asked the question again and 12 kids raised their hands.

CPR Quality Varies Among EMS Personnel
The quality of CPR (cardiopulmonary resuscitation) given to victims may vary depending on the EMS department or hospital administering it, according to the American Heart Association.  “There have been huge advances in CPR and there’s no question that high-quality CPR saves lives,” said Peter Meaney, MD, MPH, an assistant professor of anesthesia and critical care at Children’s Hospital of Philadelphia and author of a new statement on quality CPR for the AHA. “Right now,” said Meaney, “there is wide variability in the quality of CPR—and we can do better.”  Each year in the United States, more than a half-million children and adults suffer cardiac arrest, but survival rates vary significantly: 3 percent to 16 percent for arrests outside of hospitals and 12 percent to 22 percent in hospitals, according to the study authors.

In its statement the AHA offered some recommendations to improve CPR quality:

• Minimize interruptions to chest compressions.
• Provide the right rate of compressions—100 to 120 per minute are optimal for survival.
• Give deep enough compressions—at least 2 inches for adults and at least 1/3 the depth of the chest in infants and children.
• Give no more than 12 rescue breaths a minute, with the chest just visibly rising, so pressure from the breath doesn’t slow blood flow.

The AHA recommends that to ensure quality improvement, providers, managers, institutions and systems of care should do debriefings, follow CPR delivery checklists, measure patient response measurements, provide frequent refresher courses and participate in CPR data registries. Read more on heart health.

Minority Children Less Likely to Receive ADHD Diagnosis
Minority children are less likely than their white counterparts to be diagnosed with attention deficit hyperactivity disorder (ADHD), according to a new study in the journal Pediatrics. Compared to white children, Hispanic children were 50 percent less likely, black children were 69 percent less likely and minority children overall were 46 less likely. The health care disparities start as early as kindergarten and last at least through the eighth grade, and the lack of access to medications and specialized learning programs puts them at a disadvantage in terms of learning and behavior. Researchers say the findings demonstrate the need for improved ADHD awareness and questioning by health care providers, school psychologists and teachers. Read more on health disparities.

NCI Issues Guidelines to Speed Up Clinical Trials
Opening a clinical trial can sometimes take years, which can slow down introduction of new or improved therapies. The National Cancer Institute (NCI) has issued new recommendations to help get trials underway. Under the new guidelines, the target time to open a trial should be should be 210 days from the start date for the first two phases of clinical trials which assess safety and  effectiveness in a small number of patients,  and 300 days for phase III trials which include a much larger number of participants. According to NCI incorporating the new guidelines in some recent trials has sped up the start date for those trials. Read more on cancer.